联合检测血清及腹水中的肿瘤指标对腹水性质鉴别诊断的价值  

The value of combined detection of tumor markers in serum and ascites in differential diagnosis of ascites properties

作　　者：彭超男 刘肇修[1] 江枫[1] 鲍柏军[1] 徐伟松[2] 倪润洲[1] 肖明兵[1,3] PENG Chaonan;LIU Zhaoxiu;JIANG Feng;BAO Baijun;XU Weisong;NI Runzhou;XIAO Mingbing(Department of Gastroenterology,the Affiliated Hospital of Nantong University,Nantong 226001;Department of Gastroenterology,Nantong Second People′s Hospital,Jiangsu Province;Clinical Medical Research Center,the Affiliated Hospital of Nantong University)

机构地区：[1]南通大学附属医院消化内科,南通226001 [2]江苏省南通市第二人民医院消化内科 [3]南通大学附属医院临床医学研究中心

出　　处：《南通大学学报（医学版）》2020年第6期495-498,共4页Journal of Nantong University(Medical sciences)

基　　金：国家自然科学基金资助项目(81602114);江苏省社会发展面上项目(BE2019692);江苏省卫健委面上项目(H2019072);南通市科技计划项目(MS22020005,MS12019018,MS12019020,MSZ19177)。

摘　　要：目的:分析血清及腹水癌胚抗原(carcinoembryonic antigen,CEA)、糖链抗原19-9(carbohydrate antigen 19-9,CA19-9)及糖链抗原-125(carbohydrate antigen 125,CA125)水平在良、恶性腹水鉴别诊断中的应用价值。方法:选择良性腹水患者67例,恶性腹水患者44例,回顾性研究患者血清及腹水中CEA、CA19-9及CA125的水平,通过绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线),分析这些肿瘤指标对腹水良、恶性的鉴别诊断价值及最佳截点、灵敏度、特异度和准确度,并进一步探讨联合检测对腹水鉴别诊断的价值。结果:患者血清中的CEA和CA125水平在良、恶性腹水两组间差异均无统计学意义(均P>0.05),但血清中CA19-9水平在恶性腹水组中明显高于良性腹水组(P<0.05),诊断界值为46.75 U/mL。患者腹水中的CEA、CA19-9及CA125水平在恶性腹水组中均明显高于良性腹水组(均P<0.05),三者的诊断界值分别为1.50 ng/mL、26.90 U/mL及822.95 U/mL。腹水CEA分别与血清CA19-9或腹水CA19-9联合检测可以大大提高对恶性腹水诊断的灵敏度,且保持较好的诊断特异度及准确度。结论:血清CEA和CA125对良、恶性腹水无鉴别诊断价值;血清CA19-9和腹水CEA、CA19-9及CA125对良、恶性腹水有鉴别诊断价值;联合检测血清及腹水的肿瘤指标,可提高对恶性腹水的诊断与价值。Objective:To analyze the application value of serum and ascites carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),carbohydrate antigen 125(CA125)in differential diagnosis of benign and malignant ascites.Methods:67 patients with benign ascites and 44 patients with malignant ascites were selected,to study retrospectively levels of serum and ascites CEA,CA19-9 and CA125.By drawing receiver operating characteristic curve(ROC curve),the value of these tumor indexes in the differential diagnosis of ascites,the best cut-off point,sensitivity,specificity and accuracy were analyzed,and the value of combined detection in the differential diagnosis of ascites was further discussed.Results:There was no significant difference in serum CEA and CA125 levels between benign and malignant ascites(P>0.05),but the serum CA19-9 level in malignant ascites was significantly higher than that in benign ascites(P<0.05),and the diagnostic threshold was 46.75 U/mL.The levels of CEA,CA19-9 and CA125 in the ascites of patients with malignant ascites were significantly higher than those of patients with benign ascites(P<0.05).The diagnostic thresholds of these three indicator were 1.50 ng/mL,26.90 U/mL and 822.95 U/mL respectively.The combined detection of CEA in ascites and serum CA19-9 or CA19-9 in ascites can greatly improve the sensitivity of the diagnosis of malignant ascites,and maintain a good specificity and accuracy of the diagnosis.Conciusion:Serum CEA and CA125 have no value in differential diagnosis of benign and malignant ascites;serum CA19-9 and ascites CEA,CA19-9 and CA125 have value in differential diagnosis of benign and malignant ascites;combined detection of tumor indexes of serum and ascites can improve the value in diagnosis of malignant ascites.

关 键 词：良性腹水 恶性腹水 肿瘤指标 血清 

分 类 号：R442.5[医药卫生—诊断学]